Since 1973 when the specific pattern of malformation referred to as the Fetal Alcohol Syndrome (FAS) was first delineated, it has become clear that prenatal alcohol exposure is associated with a broad spectrum of structural anomalies as well as neurobehavioral deficits now referred to as the Fetal Alcohol Spectrum Disorder (FASD). However, the full range of structural anomalies in children prenatally exposed to alcohol is unknown and the incidence of specific anomalies or clusters of anomalies associated with specific patterns of prenatal alcohol consumption are poorly understood. Over the previous three years of the Consortium, the Dysmorphology Core has established a standard comprehensive protocol for physical evaluation of children in order to assure consistency in identification of the broad spectrum of features that constitute FASD at all sites. We propose to continue to support these activities throughout the renewal period in children during the first year of life at Consortium sites in prospective studies in Moscow Region, Russia, and Rivne, Ukraine as well as in older children in retrospective studies in Los Angeles, CA, San Diego, CA, Albuquerque, NM, the Northern Plains states, Atlanta, GA, and Cape Town, South Africa. Identification of large numbers of children at various ages with FAS as well as those with some features of the disorder but not enough to presently qualify them for that diagnosis (FASD), each of whom has received a standardized clinical examination, as well as neurobehavioral evaluation, neuroimaging studies, 3D photographs and, in the prospective studies, prenatal ultrasound studies, will provide the opportunity to address hypotheses regarding the relationship between FASD-related structural defects identified through the standard physical examination with complementary diagnostic methods that are being tested in other Consortium projects. The specific aims of this project are to assure consistency as well as accuracy in recognition of FASD at all CIFASD project sites where children are being evaluated; to delineate the full range of structural anomalies in children prenatally exposed to alcohol in order to determine the boundaries that encompass FASD in prospective as well as retrospective studies involved in the Consortium; to identify specific structural features or clusters of features that are predictive of or correlated with deficits in neurobehavioral development across developmental ages spanning from infancy to adolescence; to correlate the specific structural features or clusters of features identified on the CIFASD standard physical examination with alternative or complementary methods that are being tested in other CIFASD projects; and to better understand the extent to which structural features of FASD are related to specific defects in the development of the brain. [unreadable] [unreadable] [unreadable]